Provider Demographics
NPI:1598855884
Name:RUTH, KIMBERLY SUE (MS,CAC,LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:RUTH
Suffix:
Gender:F
Credentials:MS,CAC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1276
Mailing Address - Country:US
Mailing Address - Phone:724-938-2783
Mailing Address - Fax:
Practice Address - Street 1:341 STORY RD
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-2666
Practice Address - Country:US
Practice Address - Phone:724-468-3999
Practice Address - Fax:724-468-0039
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116587OtherVBH OF PA PROVIDER NUMBER